How much does it cost to treat prostatitis?

A study in people from different countries showed that 2-10% of adult men experience symptoms that indicate prostate problems during their lifetime.

Any urinary disorder is a wake-up call and self-medication in this case should be ruled out. However, problems are not always associated with prostatitis.

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Our articles are written with passion for medicine based on evidence. We refer to reliable sources and ask for feedback from reliable doctors. But remember: you and your doctor are responsible for your health. We do not write recipes, we make suggestions. It is up to you to rely on our point of view or not.

How the prostate works

The prostate, or prostate, is a walnut-like organ located just below the bladder. Between the halves of the "nut" passes the urethra - a tube through which urine is secreted from the bladder and sperm from the testicles.

The main function of the prostateconsists in the production of a secretion that is part of the sperm. Thanks to this secret, the sperm can move. The second function of the prostate is to contract, allowing ejaculation, that is, ejaculation.

Next to the prostate are the sperm vesicles that attach to the vas deferens, through which sperm leave the genitals. Sperm vesicles produce the liquid part of the sperm and store the prostatic secretion.

The secret of the prostate is a mixture of citric acid and enzymes. This fluid dilutes the sperm, which flows into the urethra from the testicles vas deferens.

Prostate problems do not always lead to erection problems

In the vast majority of cases, sexual dysfunction is not associated with prostate problems because there is no natural connection between the prostate and the erection mechanism.

But disturbed urination, suffering from incomplete emptying of the bladder, pain or discomfort associated with inflammation, lead to the fact that a person begins to feel nervous and shy. Because of this, psychological problems arise - as a rule, they are the ones that negatively affect the erection.

What is prostatitis?

Prostatitis is an inflammation of the prostate associated with pathogenic germs or other non-infectious causes. Sometimes inflammation also affects the seminal vesicles - this is called cystitis.

At the same time, inflammation of the prostate does not always lead to pain and problems with urination and the presence of unpleasant symptoms is not necessarily related to inflammation of the gland.

To avoid confusion, urologists around the world use the US National Institutes of Health, Digestive and Kidney Survey, or NIDDK classification.

To simplify a bit, the classification divides prostatitis into bacterial and bacterial, ie it is not related to bacteria. This approach helps doctors make an important decision - whether to prescribe antibiotics and extra medication. Antibiotics for all patients with suspected prostatitis are wrong because non-microbial forms of prostatitis are more common than bacterial prostatitis. Taking unnecessary antibiotics is bad for your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.A disease most often caused by typical pathogens of urinary tract infections: for example, E. coli, Klebsiella and Enterobacter.

As a rule, the disease starts unexpectedly and is accompanied by a general deterioration of well-being. The temperature rises to 38-39 ° C, with some people feeling weak, severe pain or burning in the perineum, scrotum or anus, lower abdomen and sometimes muscles. Some people experience pain during ejaculation. Sometimes with bacterial prostatitis, there is frequent, difficult and painful urination.

Chronic bacterial prostatitis.This disease can also be caused by microbial features of acute prostatitis. The disease is considered chronic if the symptoms last for at least three months.

The symptoms of chronic bacterial prostatitis are similar to those of acute, but may be less severe or less severe. Fever and weakness are usually absent, lower abdominal pain is more painful than sharp, but it is difficult to start urinating and empty the bladder completely. In addition, the unpleasant symptoms may temporarily disappear and, after a while, reappear.

Anyone can get sick with acute and chronic bacterial prostatitis. But those who are most at risk are those who are most at risk for exposure to germs: those who have sex, especially anal sex, without a condom, patients with a urinary tract infection, and people who have recently had surgery or a prostate biopsy.

Chronic bacterial prostatitis associated with inflammation.The symptoms of inflammatory non-bacterial prostatitis are very similar to those of acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria in the semen, prostate gland and urine, but the leukocyte count will be high - this indicates inflammation of the prostate.

Chronic bacterial prostatitis or chronic pelvic pain syndrome, not associated with inflammation.The symptoms also mimic acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in the semen, prostate gland and urine - this indicates that the prostate is not inflamed.

In the case of non-bacterial forms of prostatitis, it is always possible to understand what causes the disease to develop. Risk groups are also difficult to identify.

Asymptomatic inflammatory prostatitis.This form of the disease does not cause discomfort. Most often, inflammation is discovered by chance when the patient is examined for other problems, such as infertility.

How is prostatitis different from prostate adenoma?

In about 8% of men after the age of 40, the prostate begins to grow in size - this is called prostate adenoma or benign prostatic hyperplasia. An overactive prostate constricts the urethra and because of this, problems with urination can begin: too frequent urge to use the toilet or leakage of urine. When experiencing symptoms of adenoma, some patients may assume that they have developed prostatitis.

While some of the symptoms of prostate hyperplasia may actually look like prostatitis, they are not the same thing. Prostatitis is an inflammation of the prostate. And an adenoma is an uncontrolled age-related and non-inflammatory prostate cell proliferation.

Adenoma can cause serious discomfort, so if you have trouble urinating, it is important to see a urologist as soon as possible. However, an adenoma is not yet as dangerous as prostatitis because it does not increase the risk of cancer.

How often is chronic bacterial prostatitis diagnosed?

According to the generalized data of the literature, worldwide, acute bacterial prostatitis occurs in 5-10% of cases and in chronic bacterial prostatitis - in 6-10% of cases. In addition, both variants of chronic bacterial prostatitis represent 80-90% of all cases of the disease.

If we do a massive microscopic examination of the prostate, we will find some signs of its inflammation in all men without exception after 40 years. But it has nothing to do with the diagnosis of chronic bacterial prostatitis.

There are many urological diseases that can hide behind the mask of chronic prostatitis, some of them are quite serious and require immediate treatment. Therefore, I recommend to all patients with prostatitis-like symptoms to undergo a more detailed examination, which will clarify the diagnosis.

How is prostatitis diagnosed?

From the patient's point of view, the symptoms of bacterial and non-bacterial prostatitis are very similar. Without consulting a urologist and special examinations, it is impossible to distinguish one form of prostatitis from another and receive quality treatment. You can make an appointment with a urologist for free according to the compulsory medical insurance contract or make an appointment with a doctor at a private clinic.

The main task of a urologist, which a patient with suspected prostatitis came to see, is to rule out other prostate diseases, for example, cancer, and to determine what form of the disease a person has. It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen. This is what a doctor has to do to figure it out.

Ask the patient about symptoms and well-being.To gather more information, your doctor may suggest answering questions from a questionnaire called the Chronic Prostatitis Symptoms Index. In some cases, in order not to waste time on the appointment, it makes sense to print the questionnaire and fill it out in advance.

Perform a physical examination.The doctor will examine the patient, paying special attention to the groin area. If there are swollen, painful lymph nodes in the groin, this increases the chance that the body is really inflamed. Usually, the test involves a digital rectal exam, which allows the doctor to assess the size, shape and condition of the prostate. The study helps to understand if the prostate is swollen. If the gland is painful to the touch, it is most likely inflammation.

It can be done without digital rectal examination

Digital rectal examinations and prostate massage are not the most enjoyable procedures. In acute inflammation, this can be painful. Some patients are so eager to avoid these procedures that they initially refuse to make an appointment with a urologist.

Digital rectal examination is a diagnostic method, but the prostate is massaged through the rectum to obtain material for laboratory analysis - the secret of the prostate. If the secret cannot be obtained, the doctor may replace the prostate secretion test with either the first urine test or a urine sample of two or three glasses. These studies allow you to determine approximately where the problem area is in the urinary system.

Sometimes, instead of this test, a semen analysis is prescribed for the same purpose. It helps to understand if prostatitis is part of male genital infections and gives information about the quality of ejaculation. In addition, the measurement of leukocytes in ejaculation makes it possible to distinguish between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If the patient is worried about an upcoming digital examination or prostate massage, I would advise you to discuss this with your doctor. Perhaps the analysis of prostate secretion, to obtain which simply requires massage, can be replaced by urine or semen analysis.

Order blood tests, urine and prostate secretions.The diagnostic standard includes microscopic examination of prostate secretion, general blood test, general urinalysis with sediment microscopy, as well as microbiological examination of urine and prostate secretions.

During microbiological studies, the patient's biological material is placed in a nutrient medium and they see which bacteria are growing in it - this allows you to clarify the diagnosis. You can get tested at a private clinic for money or for free under compulsory medical insurance.

Other tests and examinations - such as the total concentration of prostate-specific antigen (PSA) in the blood and transverse prostate ultrasound (TRUS) - are usually not performed if prostatitis is suspected. In some cases, prostate TRUS may reveal fibrosis, a scar or foci similar to a malignancy, but such studies are not indicated for all patients without exception.

How is prostatitis treated?

Treatment depends on the type of prostatitis. If the inflammation is caused by bacteria, your doctor will prescribe antibiotics. And if the bacteria have nothing to do with it, medications will be needed to treat the unpleasant symptoms of the disease.

Acute bacterial prostatitisstart treating without waiting for test results - this is called empirical antibiotic therapy. With this approach, antibiotics are prescribed based on the knowledge of the microbes that are most likely to cause prostate infections.

As a rule, patients are prescribed antibacterial drugs that penetrate well into the prostate tissue and act on the most "popular" causative agents of prostatitis and urinary tract infections.

These people who feel more or less normal and treated at home usually take antibiotics in pills. Patients with high fever who are treated in hospital are also more likely to receive injectable antibiotics. With this treatment, in most patients with acute prostatitis, the fever and pain are relieved from the second to the sixth day after starting the medication.

When the patient's temperature returns to normal and the signs of inflammation disappear, the doctor may transfer the patient from injections to pills. The total duration of antibiotic treatment is usually about 2-4 weeks.

Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique. It was once thought that it could help release excess secretions that accumulate in the gland and thus reduce its swelling. However, today most experts have reached a consensus that prostate massage should be avoided for bacterial prostatitis. This is not only painful and useless, but can also worsen the course of the disease, because as a result of the massage, bacteria can enter neighboring, uninfected tissues.

Chronic bacterial prostatitisare also treated with antibiotics that target gram-negative bacteria. Fluoroquinolones are commonly used for treatment - these antibiotics are considered quite safe. But if the doctor suspects that other microorganisms have caused prostatitis, he or she may prescribe additional antibacterial drugs without waiting for the test results.

With chronic prostatitis, antibiotics should last longer than with acute prostatitis. According to the recommendations of urologists, they are prescribed for 4-6 weeks.

Chronic bacterial prostatitisIt is not associated with bacteria, so in patients with this disease antibiotics are prescribed only if, in addition to prostatitis, they have a urinary tract infection.

As it is not clear what exactly causes bacterial prostatitis, the treatment is mainly aimed at relieving pain when urinating. To do this, doctors prescribe alpha-1-blockers, drugs that help relax the prostate muscles that compress the urethra. If the pain persists, your doctor may prescribe non-steroidal anti-inflammatory drugs. The dosage for each patient is selected separately.

Some patients with bacterial prostatitis are helped by cognitive behavioral therapy - this is the name of the sessions with a psychologist, during which a person learns to deal with pain without medication. At the same time, there is still no scientific evidence for the effectiveness of psychological help for bacterial prostatitis.

Studies in which researchers have tried to demonstrate the effectiveness of other interventions, such as acupuncture, chair electromagnetic therapy, prostate massage or transverse heat therapy, were not well designed and took very little time - usually less than 12 weeks. Thus, it is impossible to say whether all this helps or not

How to avoid prostatitis: prevention

The main reason for prostate discomfort is a sedentary lifestyle and lack of a normal sex life. Doctors believe that the highest chances of avoiding prostatitis are in men who:

1. Have safe sex regularly.
2. They regularly participate in moderate exercise.
3. Avoid hypothermia.
4. Having reached the age of 40, they undergo a urological examination every year.

Where is it best to treat prostatitis - in a public or private clinic

Most importantly, the principles of documented medicine are followed in the diagnosis and treatment of prostatitis. It just depends on the doctor - and it doesn't matter where he works.

Unfortunately, doctors in private clinics do not always follow the standards of medical care. This can lead to overdiagnosis and unnecessary treatment, so that the patient runs the risk of overpaying. In a state medical organization, the probability of compliance with all standards of diagnosis and treatment is higher. But patients should keep in mind that a full examination will take longer, sometimes much longer than during a private examination.

I remember

1. Urinary tract problems in men are common, but do not always occur in prostatitis. To understand exactly what is happening to a person, you need to undergo a thorough examination.
2. Prostate problems rarely lead to erection difficulties. Usually, with prostatitis, it weakens due to psychological problems that arise in the context of unpleasant symptoms.
3. Not every form of prostatitis is caused by bacteria: 80-90% have nothing to do with it. If a person with suspected prostatitis is prescribed antibiotics without additional tests, this is bad. Before taking them, it makes sense to consult another doctor.
4. A person with acute or chronic prostatitis may be given a prostate massage to collect a glandular secretion for analysis.
5. The best way to prevent prostatitis is protected sex, a healthy lifestyle and after 40 years - a regular urological examination by a doctor.